Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds
A randomized controlled trial
- David G. Armstrong, DPM, MSC, PHD123,
- Lawrence A. Lavery, DPM, MPH4,
- Stephanie Wu, DPM, MS2 and
- Andrew J.M. Boulton, MD, FRCP3
- 1Center for Lower Extremity Ambulatory Research, the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine, Chicago, Illinois
- 2Department of Surgery, Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona
- 3Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, U.K
- 4Department of Surgery, Texas A&M University, Temple, Texas
- Address correspondence and reprint requests to David G. Armstrong, DPM, MSc, PhD, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL 60064. E-mail: armstrong{at}usa.net
Abstract
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an “instant” total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1−2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02).
CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
Footnotes
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D.G.A. has received an honorarium for serving on an advisory board of Royce Medical and A.J.M.B. is a paid consultant for Royce Medical.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted November 8, 2004.
- Received July 27, 2004.
- DIABETES CARE
